An update of systematic reviews examining the effectiveness of conservative physiotherapy interventions for subacromial shoulder pain
Background: Subacromial shoulder pain (SSP) is a frequently diagnosed shoulder complaint. Management often involves an exercise programme but may include many other interventions. The aim of this review is to update the systematic review published by Littlewood et al. in 2013, which focused on evaluating the effectiveness of interventions within the scope of physiotherapy including exercise, manual therapy, electrotherapy and combined or multimodal approaches. Methods: An electronic search of Pubmed, Web of Science and CINAHL was undertaken. Methodological quality was assessed using the AMSTAR-checklist for systematic reviews. Results: Sixteen systematic reviews were retrieved. Methodological quality was variable. A strong recommendation can be made for exercise therapy as first-line treatment to improve pain, mobility and function in patients with SSP. Manual therapy may be integrated, with strong recommendation, as additional therapy. Moderate evidence of no effect was found for other commonly prescribed interventions, such as laser therapy, extracorporeal shock wave therapy, pulsed electromagnetic and ultrasound. Conclusions: Evidence for the use of exercise therapy as an intervention for SSP is increasing and strengthening. Ongoing research is required to provide guidance on exercise type, dose, duration and expected outcomes. A strong recommendation may be made regarding the inclusion of manual therapy in the initial treatment phase.